Aspirin Plus Heparin or Aspirini Alone in Woman

8/8/2019 Aspirin Plus Heparin or Aspirini Alone in Woman

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Fasilitator :

Dr. Abram Siregar Sp.OGBy :

Yafet Yanri Sirupang (04-136)

Fasilitator :

Dr. Abram Siregar Sp.OGBy :

Yafet Yanri Sirupang (04-136)


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Approximately 1% of all women

trying to conceive

Defined as 3 previous miscarriages

when recurrent miscarriage is defined as 2

previous miscarriages, the proportion rises to 5%.


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Which would improve theWhich would improve the

livelive--birth rate among women withbirth rate among women withunexplainedunexplained

recurrent miscarriage in thisrecurrent miscarriage in thisstudy??study??

Aspirin combined withAspirin combined with

lowlow--molecularmolecular--weight heparinweight heparin

Aspirin aloneAspirin alone

Compared with placeboCompared with placebo


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Study Population

Evaluated patients at 3 universityhospitals and 5 teaching hospitals in theNetherlands, February 2004 - January

2008. Women 18 - 42 years unexplained

recurrent miscarriage , attempting toconceive, or pregnant with a gestationalage 6 weeks.

Previous miscarriage pregnancy lossat a gestational age of 20 weeks.

Recurrent miscarriage 2miscarriages (ACOG)


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Study Design and Treatment Regimen

Aspirin in the form ofcalcium carbasalate

100 mg daily dose

equivalent to 80 mg

of acetylsalicylicacid

Aspirin or placebo- started at the time of

randomization

- continued 36

weeks GA- stopped

miscarriage, adiagnosis of ectopicpregnancy, orpremature delivery.

LMWH in the formof nadroparin

subcutaneously at adaily dose of 2850IU

Initiated when aviable intrauterinepregnancy wasconfirmed on USG,- starting at 6 weeks of

gestation,- continued throughoutpregnancy


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Outcome Measures The primary outcome : live births.

Secondary outcomes :

- miscarriage,

- IUFD (fetal death after 20 weeks of gestation),

- and obstetrical complications such :1. preeclampsia,

2. the HELLP syndrome (hemolysis, elevatedliver enzymes, and a low platelet count),

3. IUGR (birth weight below the 10th percentile

for gestational age and sex),4. placental abruption, and

5. premature delivery.


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Combination

AspirinOnly

Plasebo

121

120

123

A total of 364 women

were enrolled, with

-123 the combinationtherapy group,

-120 the aspirin only group

-121 to the placebo


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becamepregnant(299)

Nopregnant(65)

L

ivebirth(65.9%)

No LiveBirth(34.1%)


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In analyses involving women who

became pregnant, live-birth rates also

did not different significantly among the

three groups, with rates of- 69.1% in the combination-therapy

group,

- 61.6% in the aspirin-only group, and

- 6 .0% in the placebo group


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Increased tendency significantly more common

the combination-therapy group

PlaceboombinationTherapy


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Neither aspirin combined with heparin(nadroparin ) or aspirin alone improved thechance of a live birth in women with a historyof unexplained recurrent miscarriage.

Live-birth rates were 54.5% in thecombination therapy group, 50.8% in theaspirin-only group, and 5 .0% in the placebogroup. Among women who becamepregnant, these rates were69.1%, 61.6%, and 6 .0%, respectively.

Side effects, most notably an increasedtendency to bruise and swelling or itching atthe injection site, occurred in almost half thewomen in the combination therapy group.


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The hypothesis that women with

unexplained recurrent miscarriagemight benefit from aspirin, heparin, orboth was based on a presumption thatthis condition might be caused bythrombosis in decidual vessels.

Likewise, we found no significantbenefits in other subgroups, including

women with inherited thrombophilia(who might be most likely to benefitfrom treatment with heparin or aspirin


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In conclusion, our findings do not

support the hypothesis that either

combination therapy with aspirin

and Heparin (nadroparin) or aspirinalone improves the chance of a

live birth for women with

unexplained recurrent miscarriage.


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Aspirin Plus Heparin or Aspirini Alone in Woman